Ethical challenges with social media

When a patient is communicating with a provider online, it is "quite easy for a physician to cross ethical boundaries that are inherent to the physician-patient relationship," says Toby Schonfeld, PhD, associate professor of medicine and director of the master of arts in bioethics program at the Center for Ethics at Emory University in Atlanta.

"It can be difficult to both communicate meaning and to interpret meaning simply by reading text," says Schonfeld. "Not everyone is equally gifted in clear communication."

Patients may fail to include the severity, frequency, and specificity of their symptoms, they may fail to describe an important symptom or to prioritize symptoms in a way that is diagnostically appropriate, or may fail to emphasize the true nature of their condition.

"Physicians may be unable to recommend interventions or to tailor therapies to a particular patient if the physician is only getting partial information," says Schonfeld. Health care providers get important non-verbal cues from patients when they see them face-to-face, she adds, and electronic communication eliminates this important tool. Here are other ethical challenges involving online patient-provider communication:

Patient confidentiality may be violated.

Email is only as secure as the service provider and the individual computer's settings are set to be, says Schonfeld, and many individuals ignore these safeguards.

While academic medical centers often have encryption systems for their communication involving protected health information, retrieving this information requires another step that not all patients will be willing or equipped to take, adds Schonfeld.

Communicating with health care providers via text or a social media site gives the provider access to details of one's attitudes, habits, or beliefs that the patient might otherwise like to keep secret from their providers, says Schonfeld. "I have a right to safeguard my information and only disclose what I choose," she underscores. "If the provider goes trolling for information about me on the Internet, he may find out information I have deliberately withheld for whatever reason."

Patients may learn personal information about providers.

"Communication via some of these sites will require patients to be 'linked' to their health care providers in a way that may, in fact, compromise that provider's privacy," she adds.

Some providers create separate sites for their professional and personal uses, but making sure cross-over is limited can be a challenge, says Schonfeld.

Misunderstandings may occur.

Providers should think in advance about whether or not they are prepared to engage in electronic communication with their patients, and if so, to what extent, she advises.

"These practices should be made clear to patients at the outset of the relationship," says Schonfeld. "That way, expectations are clear from the beginning."